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Low-dose inhaled and nasal corticosteroid use and the risk of cataracts

¹ Division of Clinical Epidemiology, and ⁵ Dept of Ophthalmology, Royal Victoria Hospital, and ² Division of Respiratory Medicine, McGill University Health Center, and ³ Dept of Epidemiology and Biostatistics and of Medicine, McGill University, and ⁴ Dept of Respiratory Medicine, Mount Sinai Hospital and Respiratory Medicine Service, Fleury Hospital Centre, Montreal, QC, Canada.

CORRESPONDENCE: P. Ernst, Division of Clinical Epidemiology, Royal Victoria Hospital, 687 Pine Avenue West, Ross 4.29, Montreal, Québec H3A 1A1, Canada. Fax: 1 5148431493. E-mail: Pierre.ernst{at}clinepi.mcgill.ca

Keywords: Asthma, cataracts, chronic obstructive pulmonary disease, elderly, inhaled corticosteroids, nasal corticosteroids

Received: April 11, 2005
Accepted January 20, 2006

Orally inhaled corticosteroid use has been convincingly linked to an increase in the risk of cataracts, although the risk at lower doses in common use remains uncertain. The potential risk of cataracts with the use of nasal corticosteroids is unknown.

A matched nested case–control analysis was performed in a population-based cohort of elderly people who had been dispensed medications for airway disease, as identified through a universal drug benefit plan.

Inhaled corticosteroid use was associated with a dose-related increase in both the risk of all cataracts and severe cataracts requiring extraction, and the increase in risk of severe cataracts was apparent even at daily doses of 500 µg. An excess risk with nasal corticosteroids was not apparent for severe cataracts.

It is concluded that, among the elderly, even low doses of inhaled corticosteroids are associated with a small but significant excess risk of cataracts requiring extraction. Such an excess risk was not observed with nasal corticosteroids.

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